title: Clinical manifestations of infants with nutritional vitamin B deficiency due to maternal dietary deficiency.
abstract: OBJECTIVE
  In developing countries, nutritional vitamin B(12) deficiency in infants due to maternal diet without adequate protein of animal origin has some characteristic clinical features. In this study, haematological, neurological and gastrointestinal characteristics of nutritional vitamin B(12) deficiency are presented.
  
  
  METHODS
  Hospital records of 27 infants diagnosed in a paediatric haematology unit between 2000 and 2008 were evaluated retrospectively.
  
  
  RESULTS
  The median age at diagnosis was 10.5 months (3-24 months). All the infants were exclusively breast fed and they presented with severe nonspecific manifestations, such as weakness, failure to thrive, refusal to wean, vomiting, developmental delay, irritability and tremor in addition to megaloblastic anaemia. The diagnosis was confirmed by complete blood counts, blood and marrow smears and serum vitamin B(12) and folic acid levels. The median haemoglobin level was 6.4 g/dL (3.1-10.6) and mean corpuscular volume (MCV) was 96.8 fL (73-112.3). Some patients also had thrombocytopaenia and neutropaenia. All the infants showed clinical and haematological improvement with vitamin B(12) administration. Patients with severe anaemia causing heart failure received packed red blood cell transfusions as the initial therapy.
  
  
  CONCLUSIONS
  Paediatricians must consider nutritional vitamin B(12) deficiency due to maternal dietary deficiency in the differential diagnosis of some gastrointestinal, haematological, developmental and neurological disorders of infants with poor socioeconomic status. Delay in diagnosis may cause irreversible neurological damage.
authors.affiliation: Department of Pediatrics, Division of Hematology, Kocaeli University, Kocaeli, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Zengin
authors.forename: N
authors.initials: N
authors.lastname: Sarper
authors.forename: S
authors.initials: S
authors.lastname: Caki Kiliç
mesh_terms: D000749:Anemia, Megaloblastic / Q000209:etiology / Q000503:physiopathology*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007225:Infant Food; D007231:Infant, Newborn; D008297:Male; D008429:Maternal Welfare; D009752:Nutritional Status; D012189:Retrospective Studies; D012307:Risk Factors; D014805:Vitamin B 12 / Q000627:therapeutic use*; D014806:Vitamin B 12 Deficiency / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D014805:Vitamin B 12